by Toni Pyke                Ireland                                                                    09.12.2023
Justice, Peace and Ecology Coordinator
Association of Leaders of Missionaries and Religious of Ireland AMRI

During the weeks of Advent and Christmas Day, AMRI along with the MMMs, will reflect on the reality of the lives of the women and girls around the world at risk of, or living with, obstetric fistula.  Advent is an opportune moment to contemplate the experience of motherhood, as Mary awaits the birth of her child, Jesus.  Similarly, to the women across the world who live with obstetric fistula, Mary was also a young mother living in poverty and who did not have access to appropriate ante-natal care or medical intervention.  The birth of her baby was a gift of life to humanity, so that we can all be free.

This Advent, we invite you to consider mothers around the world and to pray for the safe delivery of their child, especially those women who are at risk of obstetric fistula.  That every woman, everywhere can experience a safe pregnancy and delivery. Safe motherhood is about human dignity and is a human right.

“…We sold our livestock to raise money for treatment in five hospitals, but I was not healed…I stopped attending Church, due to the foul smell and walking difficulties. We stopped sharing a bed and my husband started going outside the marriage because of the foul smell. I also sold my 3 hectares of land for treatment and I closed my fruit business and started tilling other people’s farms for my family.

One day, a Catholic sister informed me about Jamaa hospital, where I could be treated for free. I fundraised for the fare and travelled to the hospital and was treated for free. I got cured and went home.

I live in a grass thatched house, because I could no longer afford a better house…I used to wear pampers, but turned into using old washable rags that were used by our grandmothers.  I got well, but now I am suffering as I used to milk my cows and goats. My husband regrets marrying me and complains he has been made poor by my obstetric fistula condition…  Obstetric fistula cripples women because one can bath more than 3 times a day and use lubricants but is still not hygienically clean. The urine is ever leaking, leaving a foul smell in the house…

…I urge the county governments to include women with fistula in free maternity delivery. We urge counties to construct roads, health facilities and to train and provide medics with expertise on fistula and treatment at all hospitals. I can tell all women that obstetric fistula is treatable, and one can get back to her normal duties.”

These are the spoken words of Anna John from Kitui County in Kenya who experienced an obstetric fistula in 2007. With support from the Good Shepherd Sisters in Kenya, Anna was able to access the necessary surgery to repair her fistula. She recorded her story to share in a webinar entitled: Obstetric Fistula – A Human Rights Perspective hosted by the Association of Leaders of Missionaries and Religious of Ireland (AMRI) on 17 November 2021. The focus of the webinar was to explore and reflect on the human rights realities of women and girls who are impacted by obstetric fistula.

What is obstetric fistula?
Obstetric fistula or vesicovaginal fistula (VVF) occurs after a prolonged or obstructed labour that results in an abnormal opening between a woman’s birth canal and her urinary tract and/or rectum. The physical injury results in one or both urinal and faecal incontinence and other medical complications such as infection.

In countries with high quality and affordable health-care systems, obstetric fistula has virtually been eradicated. Yet, in countries with limited or poor healthcare facilities, some 500 000+ women and girls currently live with obstetric fistula, mostly in sub-Saharan Africa and Asia. And there are an estimated 50 000-100 000 new cases annually, although the WHO reports that these statistics are difficult to estimate accurately “due to the lack of commitment in addressing and resolving this problem”.

Obstetric fistula through obstructed labour is directly linked to one of the major causes of maternal mortality. Many women who develop fistula(e) deliver stillborn babies in the process and some can become infertile. In countries where motherhood is key to a woman’s social relevance in her community, this is devastating.